This three-year project seeks to improve care quality and safety in an ambulatory care setting through[unreadable] clinical decision support for evidence-based pharmacotherapy delivered as point-of-care reports to clinicbased[unreadable] practitioners and as population health-based alerts to care managers. This project will build upon a[unreadable] regional Health Information Exchange (HIE) network created to connect providers serving 37,000 Medicaid[unreadable] beneficiaries across traditional institutional boundaries from both rural and urban settings in a 5 county[unreadable] region in the Northern Piedmont of North Carolina. This network includes 16 private practices, 3 federally[unreadable] qualified health centers, 5 rural health clinics, 3 urgent care facilities, 10 government agencies, 5 hospitals[unreadable] and 2 cross-disciplinary care management teams. Rules for evidence-based pharmacotherapy for priority[unreadable] areas identified by the Institute of Medicine (IOM) will be encoded in a standards-based decision support tool[unreadable] that has been in use within the HIE network for three years to promote population health management.[unreadable] These rules will be designed to function using routinely available claims and scheduling data in order to[unreadable] make the proposed approach more generalized, portable and scalable. This approach will support both[unreadable] traditional clinic-based models of care, and new care models including population health management and[unreadable] the use of cross-disciplinary teams. Under Aim 1, the existing HIE network will be enhanced to deliver[unreadable] reports comprised of patient-specific medication adherence data (% days covered by each medication) and[unreadable] evidence-based suggestions for medication management to clinicians at the point of care prior to a[unreadable] scheduled patient appointment using bidirectional facsimile technology, and to deliver notifications about[unreadable] patient-specific medication adherence asynchronously to care managers via electronic mail. Under Aim 2,[unreadable] the impact of the proposed approach will be evaluated in a randomized controlled trial involving 4,200[unreadable] patients, 248 primary care clinicians and 22 care management workers. Patients with IOM priority conditions[unreadable] will be randomly assigned by family unit to one of three groups: 1) patients for whom medication[unreadable] management suggestions are sent both to their clinic-based caregivers and their care managers; 2) patients[unreadable] for whom suggestions are sent only to their clinic-based caregivers; and 3) patients for whom no suggestions[unreadable] are sent. The primary outcome measure will be the overall rate of adherence to evidence-based[unreadable] pharmacotherapy for each study group. Under Aim 3, the economic attractiveness of the proposed[unreadable] approach will be determined. Under Aim 4, the technology and results of this study will be disseminated[unreadable] through publications and presentations. The primary study hypothesis is that adherence to evidence-based[unreadable] pharmacotherapy will be highest among patients who receive medication management information sent both[unreadable] to their clinic-based practitioners and to their care managers. The expected effect on safety/quality from this[unreadable] project will be improved adherence to evidence-based pharmacotherapy guidelines.